Evidence-Based Practice (EBP) and Working with Families
What is the difference between internal and external evidence?
External Evidence: scientific literature (ex., research shows that…)
Internal Evidence: data related to the client (ex., my data shows that…)
What's the purpose of a speech sound assessment?
1. Determine the nature and severity of speech delay/disorder
2. Provide information for decision-making about treatment
Speech involves four subsystems. What are they?
1. respiration 2. phonation 3. resonance 4. articulation
Is CAS a clinical diagnosis or a medical diagnosis?
It's a clinical diagnosis.
How do we read a speech sound development chart?
Left edge shows customary age of acquisition: when 50% of children have learned a sound
Right edge shows mastery: when 90% have mastered it
What are the three components of evidence-based practice according to ASHA?
Evidence (Internal and External)
Clinical expertise (the greatest tool there is!): Problem-solving based on the individual circumstances of the client
Client perspectives: This is specific to the client and begins with responsive listening
How does feedback (auditory and sensory) relate to speech?
Auditory: influences regulation, special awareness, and balance
Sensory: influences sensory systems (ex., vestibular, tactile)
We make adjustments based on the auditory and sensory feedback that we received
What is minimal opportition and is this a common intervention of phonological disorder therapy?
Uses minimal pairs to teach meaningful phonetic contrasts
Very common approach
What are the core traits of CAS and signs that may appear in young children as they’re learning to talk?
1. Inconsistent errors on consonants and vowels in repeated productions of syllables or words
2. Lengthened and disrupted coarticulators between sounds and syllables
3. Inappropriate prosody, especially in the realization of lexical or phrasal stress
Name two primary and two secondary characteristics of stuttering.
Primary:
Repetitions: “I, I, I, I want to go.”
Prolongations: “sssssssometimes I like to”
Blocks: “…..today is Monday.”
Secondary:
Physical manifestation of tension:
Eye blinking, loss of eye contact
Facial grimacing
Limb or head movements
Name three limitations of evidence-based practice?
Knowing the research ≠ , knowing how to use the research
Lack of evidence ≠ , contrary evidence
Translating research into natural clinic contexts
Paralysis (aka analysis paralysis): unable to make a decision due to overthinking
Can dysarthria and CAS co-occur?
Yes, they can co-occur.
What are the key principles of articulation and phonology treatment?
Articulation:
Therapy focuses on repetitive motor practice
As we move through treatment, we adjust complexity and support
Phonology:
Therapy focuses on using sound contrasts with linguistic meaning
Groups of sounds support the establishment of phonemic contrasts and take advantage of natural communication consequences
What are the principles for CAS treatment?
Establishing motor programs through motor practice
We want the focus of the word to be in the context that it's going to happen in the conversation
We want to practice it in the full motion
Give appropriate and specific feedback (using principles of motor learning)
A child has a speech sound disorder. The client has consonant and vowel errors, and these errors are generally consistent. What is the diagnosis?
Dysarthria
How can we help minimize the sense of overwhelm families can experience? (name three things)
Provide information that is relevant
Provide a manageable amount
Repeat key information in future meetings
Use written or graphic info to support understanding
Explain terminology and acronyms
Check for understanding
Name three considerations for multilingual speech assessments?
Some articulation/phonology tests are only based on monolingual English speakers
May need to use informal assessments in multilingual situations
Use parents/caregivers as a resource to help determine if the child is showing typical development
Reach out to SLPs in other countries if needed
Intelligibility in context scale can be translated into many languages
How can the international phonetic alphabet be used for articulation therapy?
We want to know what the child can do, so we can help him do what he can't do (what are the child’s strengths and needs?)
We can shape sounds using place, manner, and meaning: if there are 2 already, then we just have to shift one of those components (ex., /l/ to /r/)
Name the causes of stuttering and 2 risk factors.
Genetic: Gene mutations are found in around 10% of familial stuttering cases
Neurological:
Atypical lateralization of speech & language (lateralization can help the brain specialize)
Reduced neural connectivity in areas of movement control
Risk factors: family history, age, time since onset, gender, and other speech and language concerns
What's the difference between phonological recognition and phonological representation?
Phonological recognition is part of input. Phonological representation is part of storage.
Recognition: recognizing an acoustic stream
Representation: storage of sounds and organization of those sounds (mental lexicon for sounds and how they function together with the lexicon)
How can clinicians and professionals deal with the power differential in therapy with children, and how can they promote trust and locus of control? (name three things)
Power differential trust: offering choices and building trust: this can help them feel more in control about the things happening to them (internal locus of control)
Control of Dialogue: Because we’re working on communication, allow it to flow as naturally as possible (within reason). Use age-appropriate vocabulary
Encourage input: let them help pick the activities for therapy; as they get older, ask their input about what works for them
Explain why: Verbally explain why you’re making a particular decision about the therapy session, so they hear your reasoning
Routines and rituals can help promote security and consistency during the session
Activity: creates a form of communication. The materials are the things that allow you to use the tools in your toolbox. Strategies will be implemented in the activities. Strategies are specific to the client you are working with.
Functional: arctic (motor) and phono (linguistic)
Organic (developmental or acquired)
Motor/ neurologic: apraxia (planning), dysarthria (execution)
Structural: cleft palate and other orofacial abnormalities, structural deficits due to trauma or surgery
Sensory/ perceptual: hearing impairment
Name 5 phonological processes and their age of elimination.
Final consonant deletion:3
Stopping:3-5
Fronting:4
Cluster Reduction:4 (5 with s)
Weak Syllable Deletion:4
Depalitalization:5
Deaffrication:4
Gliding:6
Vowelization/ Vocalization:6
How can dysarthria can affect the subsystems of speech production? (name two)
Respiration:
Decreased duration of phonation
Inadequate subglottal air pressure
Atypical pausing
Phonation:
vocal quality may be breathy or harsh
difficulty adjusting pitch or loudness
Articulation:
imprecise articulation
vowel and consonant distortions
Resonance:
may have velopharyngeal dysfunction resulting in hypernasality
Explain the trends in how families have been involved in special education (there are 5) (no need to tell us specific dates).
1880-1930: Sometimes seen as a source of the child’s disability
1930-1950: Families organizing locally & nationally - the beginning of organizations to help families
1950-1960: Families developing educational programs
1950-1970: Families are recipients of professionals’ decisions
1970-Present
Families are political advocates
Families are collaborators
Parents have legal rights to make decisions about their child’s education